State, Federal and Local Officials Crack Down On Health Care Fraud

The United States Attorney General for the Northern District of Texas issued the following news release on Feb. 17, 2011:

MEDICARE FRAUD STRIKE FORCE OPERATIONS EXPAND TO DALLAS AND CHARGE SEVEN IN NORTH TEXAS AREA WITH SCHEMES TO DEFRAUD MEDICARE OF $2.8 MILLION

North Texas Arrests Part of National Strike Force Takedown;111 Defendants Charged with Submitting $225 Million in Fraudulent Claims

DALLAS Seven North Texas-area residents, including the owners and operators of two health care companies, were arrested today on charges outlined in two indictments returned by a grand jury in Dallas last week and unsealed today, that they participated in a series of separate schemes in the North Texas area to defraud the Medicare program of more than $2.8 million, announced U.S. Attorney James T. Jacks of the Northern District of Texas, at a press conference in Dallas today. Mike Fields, Special Agent in Charge of the Dallas Regional Office of the Inspector General (OIG) for the Department of Health & Human Services (HHS), Robert E. Casey Jr., Special Agent in Charge, Dallas FBI Field Office, and the Texas Attorney General’s Medicaid Fraud Control Unit joined in making the announcement.

These indictments are part of a nationwide takedown by the Departments of Justice (DOJ) and HHS Medicare Fraud Strike Force, a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. These Medicare Fraud Strike Force operations have led to charges against 111 defendants for their alleged participation in Medicare fraud schemes involving more than $225 million in false billing. DOJ and HHS today announced that the Medicare Fraud Strike Force, previously operating in seven locations across the country (Miami, Los Angeles, Detroit, Houston, Brooklyn, Tampa and Baton Rouge), has expanded operations to Dallas and Chicago.

"With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country. We have safeguarded precious taxpayer dollars. And we have helped to protect our nation’s most essential health care programs, Medicare and Medicaid, said Attorney General Eric Holder. As today’s arrests prove, we are waging an aggressive fight against health care fraud.

U.S. Attorney Jacks said, Health care fraud has infiltrated almost every layer of the health care industry and the addition of a Health Care Fraud Prevention & Enforcement Action Team (HEAT) Strike Force in Dallas greatly expands law enforcement’s combined efforts in this area to root out this fraud that costs taxpayers, patients and private insurers millions of dollars, and prosecute those responsible. Today’s arrests in our area are merely the beginning of the Strike Force’s efforts.

Since their inception in March 2007, Strike Force operations in nine districts, have indicted 1000 defendants who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Financial kickbacks and fraudulent medical billing as alleged here today subvert the nation’s Medicare program by steering tax dollars into provider pockets, rather than sound patient care, said Special Agent in Charge Mike Fields. Today’s actions are part of a coordinated, nationwide sweep in the OIG’s continuing battle against the very real threat that health care fraud poses to the viability of the Medicare program.

Special Agent in Charge Casey stated, Medicare fraud is a significant problem in north Texas, taking taxpayers’ dollars and putting them in the pockets of criminals. The FBI and its partners, through the HEAT Strike Force, have concentrated extensive resources toward combating health care fraud. We have made the commitment to investigate and criminally prosecute such fraud to the fullest extent of the law.

Texas Attorney General Greg Abbott said, Thanks to an outstanding effort by state and federal law enforcement officers, 15 suspects have been arrested in this takedown in Dallas and Houston for defrauding the taxpayer-funded Medicaid program. The Texas Attorney General's Office is committed to working with federal law enforcement authorities to reduce Medicaid fraud. Today's arrests demonstrate the importance - and effectiveness - of collaborative law enforcement.

U.S. v. Sylvia Jean Willett, et al.

In this indictment, Sylvia Jean Willett, 60, the owner and operator of JS&H Orthopedic, Inc., a DME supplier on Vickery Blvd., in Fort Worth, Texas, and her husband, Hugh Willett, 67, are each charged with one count of conspiracy to commit health care fraud and five substantive counts of health care fraud. The indictment alleges that from September 2008 through December 2010, the Willetts conspired to defraud Medicare by submitting at least $1.8 million in claims to Medicare for DME that JS&H purportedly provided, when in fact, JS&H did not provide the DME for which Medicare was billed. After the Medicare payments were deposited into JS&H bank accounts, the Willetts would transfer the proceeds of the fraud to themselves and co-conspirators.

The conspiracy to commit health care fraud count and the five substantive counts of conspiracy to commit health care fraud each carry a maximum statutory sentence of 10 years in prison and a $250,000 fine, upon conviction.

U.S. v. Ernest Amadi, et al.

This indictment charges Ernest Amadi, 53, the CEO and Administrator of Alliance Healthcare Services, L.P., located on Estate Lane in Dallas, and four co-defendants, George Opurum, 60, Agatha Opurum, 53, Edith Amadi, 49, and Ollie Futrell, 55, each with one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the U.S. and to receive and pay health care kickbacks. Defendant Futrell, who was a patient recruiter for Alliance, is also charged with three counts of payment and receipt of health care kickbacks.

According to the indictment, Ernest Amadi and his wife, Edith Amadi, both of Wylie, Texas, as well as George Opurum and his wife, Agatha Opurum, both of Richardson, Texas, paid kickbacks to Ollie Futrell, of Garland, Texas, for referring Medicare patients to Alliance. Edith Amadi and Agatha Opurum were nurses at Alliance. George Opurum was the CFO and Alternate Administrator of Alliance. From November 2008 through November 2010, Alliance billed Medicare approximately $1,031,758 on behalf of Medicare beneficiaries to whom it purportedly provided home health care services.

Each of the conspiracy to defraud the U.S. and to receive and pay health care kickbacks counts and each of the substantive counts of payment and receipt of health care kickbacks carries a maximum statutory sentence of five years in prison and a $250,000 fine, upon conviction.

An indictment is an accusation by a federal grand jury, and a defendant is entitled to the presumption of innocence unless proven guilty.

These cases are being prosecuted by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Northern District of Texas.

To learn more about the HEAT Strike Force, please visit: http://www.hhs.gov/stopmedicarefraud.gov